Paediatrics Urology Unit
Prostate Growth And Greenlight Method
Premature Ejaculation (Early-Fast-Rapid Ejaculation)
Penile Prosthesis İmplantation
Sexually Transmitted Diseases (Venereal Diseases)
Testicle And Epididymis İnfection
• Assoc. Prof. Ömer ÖGE, MD
• Işık H. ÖZGÜ, MD
• Uğur SARAÇOĞLU, MD
What is Hydrocele?
Male reproductive organ is covered with a protective sheath on testicular double-layer membrane structure. There is a little fluid between these two plates. This fluid is secreted by any of the layers; it ensures easy movement of testis inside bags and in this way, it ensures its easy protection against external impacts. Fluid secreted by one of these two layers is absorbed by the other and this process is in balance state. Disruption of this balance against absorption leads to increase of fluid volume between two layers and formation of a bag filled with fluid characterized by swelling of bag. This is called "hydrocele".
What are the causes of hydrocele?
Hydrocele can be seen both in childhood and adult age. The cause in children is non-closure of canal (processus vaginalis) automatically closed following birth and located between leaves covering testis with mostly abdominal internal membrane. In adults, it is not known exactly why it occurs. Moreover, it may emerge as a symptom of diseases such as rotation of testis around itself, blood build-up and lymphatic drainage disruption (testicular torsion), testicular inflammation, testicular trauma and testicular tumours. Hydrocele quickly emerges in these diseases. Besides, hydrocele may also rarely develop depending on disruption of testicular lymphatic drainage following inguinal varicocelectomy and inguinal hernia.
Symptoms and Course of Disease
Hydrocele gives symptoms in the form of swelling in bags. This swelling is generally painless and tends to grow in a slow mode over time. Hydrocele is benign and does not turn into cancer and its frequency increases with age. It is followed up or treated based on desire of the patient, size of swelling or whether it causes pain or cosmetic problem or not. In children, there is swelling in post-partum bags and this swelling becomes more distinctive with increase of intra-abdominal pressure. Child hydrocele can be together or separately seen with hernia. While surgical treatment is performed at once in those seen together with hernia, since recovery can automatically occur over time in those seen separately, 2 years of age can be generally waited for treatment.
How Hyrocele is diagnosed?
Hydrocele usually is diagnosed easily by physical examination. When light is kept to the bags during examination, it is seen that the bag containing fluid inside penetrates light (transillumination). Light transmittance is an indicator of that mass is filled with fluid. However, it should be finalize the diagnosis with scrotal ultrasound for scrutinizing the potential underlying causes such as testicular tumour. It is defined as cystic mass yielding posterior acoustic shading, properly contoured, hypoechoic, well-circumscribed features in ultrasound examination quickly performed and relatively less costly. There is no need for other diagnostic examinations, however, if there are suspicious findings ultrasonography examinations, magnetic resonance imaging analysis can be performed for placing a real diagnosis.
2 years of age is waited for treatment in non-hernia hydrocele seen in children age. If case of no recovery in this period, it is fixed surgically. Hydroceles seen together with hernia should be fixed surgically when diagnosed. In adult hydroceles, treatment varies depending on desire of the patient and whether there is another underlying disease or not. Treatment is recommended in case of pain, cosmetic problems and hydrocele cases in sizes preventing daily activity. Treatment is applied in 2 different ways as non-surgical and surgical method.
Duration of Surgical Intervention, Hospitalization Stay Time
Intervention time of hydrocele operations vary depending on type of procedure, surgeon applying the procedure and the patient and are generally between 30-60 minutes. A drain is placed for drainage to the bag after operation and this drain is removed after 24-48 hours according to the condition and the patient is discharged. Average hospitalization stay time is 1-2 days.
What should be considered after hydrocele treatment?
This varies according to applied treatment and anesthesia type and daily chores can be done after a few day resting at home after hydrocele treatment. Since stitching material absorbed by the body for skin is used, stitches generally melt after approximately seven days; therefore, removing stitches is not required and at the end of this period, you can have a bath. The patient is usually worn with suspensory pant for lifting and supporting upwardly the bag after operation and it is recommended that this pant is continuously worn minimum one week. Generally in post-operative case, one week protective antibiotic, analgesic-anti-inflammatory medication treatment is administered for pain and inflammation and it is recommended for the patient to use them orally. Following 7-10 days after operation, the patient is invited for wound healing and infection. Full healing of tissues and normalization of swelling in the bags last for 1-2 months. After approximately two weeks sexual intercourse activation is allowed and heavy work life and sport activities after four weeks are allowed. The patient is recommended to visit for a general check after 3 months. There is no routine monitoring after treatment thereafter.